This application requests support to continue our examination of the effects of of extremely low birth weight (ELBW,<1kg) on outcomes. We have prospectively followed 219 ELBW born 1992-1995 since birth. A school matched group of 176 normal birth weight (NBW) controls were recruited at age 8 years. Results of the study at 8 years reveal very high rates of chronic conditions and special health care needs as well as cognitive and neuropsychologic deficits that have implications for learning and behavior. These result in increased family stress and burden. The children have since entered adolescence, a period of extraordinary biological, psychological and social change that pose special challenges to ELBW children. The major objective of this application is to extend the longitudinal follow up to age 14 years in order to examine the continuing impact of ELBW and the critical changes in health,development and behavior that may occur during adolescence. We present a developmental biopsychosocial framework which considers the sequelae of ELBW on outcomes of adolescence when compared to NBW children. Higher perinatal risk (mainly brain and lung injury) is predicted to result in poorer academic achievement, behavior and psychosocial adjustment. The model examines interpersonal contexts including family, peer and school relationships as mediators of perinatal risk, as well as the moderating effects of sociodemographic and intrapersonal factors such as gender and ethnicity. We also plan to examine the longitudinal changes in outcomes and their relationship to the contextual variables. We hypothesize that a) ELBW children will continue to have poorer outcomes than NBW children in health, neuropsychologic and academic function, and behavior;and negative impact on the family, b) The high rates of chronic disorders and special health care needs of the ELBW group will increase during adolescence;c) Effects of ELBW relative to NBW that will emerge will include increase in social isolation, symptoms of anxiety and depression, and diminished risk taking. The ELBW group represents the only such children followed to school age in the USA who were born in the 1990's. The findings will inform interventions designed to lessen or prevent adverse outcomes. Our data will also provide important information needed for the planning and provision of services for ELBW children who survive neonatal intensive care.